Resumo O perfil da assistência pediátrica passou por mudanças no Brasil e no mundo. Essa mudança se torna mais visível em pesquisas que tratam de dados de internação hospitalar ou de atenção ambulatorial especializada. Esse fato nos encaminha à ideia de que é nesses espaços que essas crianças e sujeitos que delas cuidam são mais visíveis e negociam decisões. Objetivamos, através de uma revisão da literatura, analisar o estado da arte das discussões e das definições sobre tomada de decisão, fazendo uma interpretação do material produzido à luz das perspectivas teóricas de Mol sobre as lógicas que se desenham a partir dos atores e de suas redes no que se refere à atenção às doenças crônicas; e a perspectiva das trocas de bens de cuidado no diálogo entre Martins e Moreira, acionando a Teoria da Dádiva. Concluímos que a tomada de decisão pode ser entendida como um processo de planejamento de cuidado onde participam familiares, pacientes e profissionais de saúde e está ligada ao modelo de cuidado centrado na família. Como dificuldades, citamos a predominância de uma lógica que privilegia uma escolha digna de crítica por oferecer risco de iniquidades, como a não discussão das opções de escolha e o acionamento das famílias prioritariamente em momentos de decisões difíceis.

Objective: To assess the correlation between plasma lactate concentrations in the first 6 hours of life and early neonatal mortality. Methods: The patients were divided in 2 groups based on the cutoff point, obtained from a receiver operating characteristic (ROC) curve, of the plasma lactate concentration that best predicted neonatal mortality during the first 3 days of life. The differences between groups and the correlations between the investigated variables and the plasma lactate concentrations measured in the first 6 hours of life were analyzed using the Chisquare, Student's t, or Mann-Whitney tests and logistic regression. Results: The best cutoff point of the plasma lactate concentration as determined by the ROC curve for death during the first 3 days of life was 4.2 mmol/L. The

Interested in exploring the construction of the negotiations present in the decision relationships in complex chronic care in pediatric outpatient settings, we approach Anselm Strauss and the concept of negotiated order and Annemarie Mol with the concept of decision logic associated with Latour actor-network theory. We used an ethnographic perspective of health research in the pediatric and stomatherapy outpatient clinics of a hospital located in the city of Rio de Janeiro, from July to December 2017. The interpretation of the field converged to two major axes: diagnosis and therapeutic itineraries, where care was performed through negotiation networks. These concerned the organization of the lives of people related to this care. This whole negotiation process took place in a hybrid scenario, marked by blurring across borders, where caregivers constantly negotiated the recognition of their children. Depending on the spaces and times of interaction, the actors moved through different identities, in a negotiation between how they recognized themselves and how they were recognized by people in complex chronic care. Negotiations in the observed care relationships took place between the uncertainties inherent to the health condition and the possibilities of living with that diagnosis.